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Accuracy and Quality of Clinical Decision Rules for Syncope in the Emergency Department: A Systematic Review and Meta-analysis


Methodology:  4/5         
Usefulness:  2.5/5
Serrano LA, Hess EP, Bellolio MF, Murad MH, Montori VM, Erwin PJ, Decker WW.
Ann Emerg Med. 2010 Oct;56(4):362-373


This systematic review and meta-analysis of multiple clinical decision rules for syncope, found the pooled sensitivity and specificity for the only 2 externally validated rules (SFSR and OESIL) were lower than that in the original study.  As a group we praised the methodological strengths of this systematic review and agreed that all syncope clinical decision rules need further development prior to being routinely incorporated into practice; but felt that the biggest flaw in this study was the heterogeneity between studies analyzed in the meta-analysis – leading us to question the pooled sensitivity and specificity results. 
By: Dr.  Koushik Krishnan
(Presented January 2013)

Epi Lesson:
As more clinical decision rules are created, this will lead to further systematic literature reviews of such rules. This raises the challenge of evaluating methodological quality of clinical decision rules. There are standards published in the literature for emergency medicine – these include: well defined and prospectively collected predictor variables, well defined clinically important outcomes and prospective validation. 
By: Dr. Lisa Calder

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